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Does Cardiopulmonary Testing Help Predict Long-Term Survival After Esophagectomy?

Lookup NU author(s): Jakub Chmelo, Rachel Khaw, Dr Rhona Sinclair, Dr Maziar Navidi, Professor Alexander PhillipsORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021, The Author(s).Background: Esophagectomy is associated with a high rate of morbidity and mortality. Preoperative cardiopulmonary fitness has been correlated with outcomes of major surgery. Variables derived from cardiopulmonary exercise testing (CPET) have been associated with postoperative outcomes. It is unclear whether preoperative cardiorespiratory fitness of patients undergoing esophagectomy is associated with long-term survival. This study aimed to evaluate whether any of the CPET variables routinely derived from patients with esophageal cancer may aid in predicting long-term survival after esophagectomy. Methods: Patients undergoing CPET followed by trans-thoracic esophagectomy for esophageal cancer with curative intent between January 2013 and January 2017 from single high-volume center were retrospectively analyzed. The relationship between predictive co-variables, including CPET variables and survival, was studied with a Cox proportional hazard model. Receiver operation curve (ROC) analysis was performed to find cutoff values for CPET variables predictive of 3-year survival. Results: The study analyzed 313 patients. The ventilatory equivalent for carbon dioxide (VE/VCO2) at the anerobic threshold was the only CPET variable independently predictive of long-term survival in the multivariable analysis (hazard ratio [HR], 1.049; 95% confidence interval [CI], 1.011–1.088; p = 0.011). Pathologic stages 3 and 4 disease was the other co-variable found to be independently predictive of survival. An ROC analysis of the VE/VCO2 failed to demonstrate a predictive cutoff value of 3-year survival (area under the curve, 0.564; 95% CI, 0.499–0.629; p = 0.056). Conclusions: A high VE/VCO2 before esophagectomy for malignant disease is an independent predictor of long-term survival and may be an important variable for clinicians to consider when counseling patients.

Publication metadata

Author(s): Chmelo J, Khaw RA, Sinclair RCF, Navidi M, Phillips AW

Publication type: Article

Publication status: Published

Journal: Annals of Surgical Oncology

Year: 2021

Volume: 28

Pages: 7291-7297

Online publication date: 26/05/2021

Acceptance date: 21/04/2021

Date deposited: 19/05/2022

ISSN (print): 1068-9265

ISSN (electronic): 1534-4681

Publisher: Springer Science and Business Media Deutschland GmbH


DOI: 10.1245/s10434-021-10136-5


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